Response from Nature Made

Here's the response from Nature Made when I emailed them about my concern that there appears to be no vitamin D in their vitamin D gelcaps.

It is the usually CYA corporate-speak that says nothing. The grammatical errors make it clear that this was a "canned" response.



Date: April 9, 2010
From: Marissa Reyes, Consumer Affairs Department
Subject: Reference #346236

Dear William Davis, MD:

We recently received your e-mail regarding Nature Made products. We regret to
hear that the quality standards of our company. [?]

Our company is called Pharmavite, and we manufacture Nature Made nutritional
supplements. We have been in business since 1971. We are committed to quality
control, and have very high quality standards. Our Quality Control personnel
sample and test all raw materials as they enter our plant, and again assay the
finished product, before final packaging.

Dietary Supplements are regulated under the FDA through DSHEA (Dietary
Supplement Health & Education Act of 1994). The United States Pharmacopoeia
(USP) establishes standards for the composition of drugs and nutritional
supplements. This voluntary non governmental organization was set up in 1820
and has officially been recognized by federal law since 1906. Standards
established by USP for products are legally enforceable by the FDA. At
Pharmavite we participate in the USP Dietary Supplement Verification Program
(DSVP). Many of our products have earned the DSVP seal and additional products
are currently being evaluated. Our DSVP certified products will have the DSVP
seal on the product label.

Our Nature Made Vitamin D 400 IU tablets have been reviewed by the USP and bears
the DSVP symbol on the label. Although the USP has not reviewed all of the
Nature Made Vitamin D supplements, all of our products go through the same
rigorous quality testing at Pharmavite. The products which have earned the seal
help us to demonstrate the high quality of our products.

We would like to look into the product(s) your patients have been using. If you
could provide the UPC and lot numbers of the product(s), we will be happy to
review our records. In addition, if you would like us to test the product(s)
that you currently have, we will be pleased to send a prepaid postage mailer so
you may return the product(s) to us so that our Quality Control Department can
examine it. Please let us know if you would like us to send you the prepaid
postage mailer.

We thank you for contacting us and hope that you will continue to use and enjoy
Nature Made products with complete confidence.

Sincerely,
Marissa Reyes
Consumer Affairs Coordinator
Pharmavite, LLC
MR:346236-10



Patients who come to the office do not provide me with the bottles nor lot numbers. In past, when I've gone to the trouble of doing this (with other companies, not Nature Made), it has come to nothing helpful. The information gets passed on to the company and we hear nothing and never learn if there was a problem, or receive some more corporate-speak letter saying everything was fine. This is obviously a liability-avoidance tactic: Admitting that something was wrong would open them up to legal risk. So, frankly, I can't be bothered.

So we are left with the unsatisfying experience of relying on street-level experiences.

For now, my advice: Avoid Nature Made vitamin D. Too many people have had blood tests demonstrating that they are not obtaining any vitamin D.

By the way, the Nature Made brand of fish oil is among the very few problem brands of fish oil we've encountered. Fish oil should be only mildly fish in smell and generally should not cause stomach upset and excessive belching if properly purified. Nature Made is excessively fishy when you smell it, suggesting oxidation. We've had repeated (dozens) of patients who have experienced difficulties with this brand. Rather than dealing with the frustrating gobbledy-gook of this company, just avoid their products.

Comments (31) -

  • Tony

    4/10/2010 1:40:39 PM |

    I've been using the NatureMade fish oil because it's frequently 2-for-1 at Rite Aid. My VAP cholesterol test was excellent while on the product, but I suppose that doesn't ensure that the product is doing anything. Thanks for the info.

  • Anonymous

    4/10/2010 3:06:53 PM |

    Fresh fish does not smell like fish. Only when the fish tissue starts to decompose does it start to smell like "fish".

  • Impudent_Observer

    4/10/2010 3:31:05 PM |

    First of all, Doc, thanks for taking the time to do this blog. It's great to have such an expert "in the trenches" practitioner helping ordinary people like me make much better decisions on keeping my heart going!
    Specifically on this post, when you write these companies, I'd suggest writing a letter and sending it by post right to the CEO.
    I've found that usually gets a better, more personalized response to my concerns.

  • gindie

    4/10/2010 3:44:38 PM |

    What is a person with very low Vitamin D levels, but prone to kidney stones, to do?

  • whatsonthemenu

    4/10/2010 4:34:04 PM |

    I wonder if that letter was generated by a worker at an overseas customer service center who, as you suggested, just opened a file and inserted text.  How many hits does your blog get?

  • Anonymous

    4/10/2010 5:36:51 PM |

    I've wondered if the USP seal on vitamins actually means anything -- apparently, it doesn't count for much.

    I have had a company actually admit to a problem with their supplements once (Jarrow), where their Ubiquinol gelcaps were leaking (found goo at the bottom of my bottle). They admitted the capsules were faulty and they planned to change the manufacturer of their gels, and even sent me a replacement bottle. So... some companies will actually admit to problems and take care of them, but that is still probably the minority.

  • Gary Wu

    4/10/2010 5:45:05 PM |

    Hi Dr. Davis,

    Have your patients had any experience with CostCo's 2000 IU vitamin D3 gelcaps?

  • Painlord2k

    4/10/2010 5:55:53 PM |

    In Italy, Vit D3 drugs are available over the counter at pharmacy. They are ultra cheap. I go for an injection every 2 months as 5 vial cost less than five €.
    What prevent US consumers from going to a pharmacy and buy registered drugs instead of supplements?
    Quality control for drug companies is surely a bit harsher than for supplement companies.
    Then, regulation can be different.

  • Nancy

    4/10/2010 8:11:24 PM |

    good to know, I used to buy Nature Made all the time... now I am wondering if the "gummy bear" vitamins and vitamin D I give my kids actually are vitamins.  What if they are just candy.  How can you tell for sure?

  • Dr. William Davis

    4/11/2010 1:04:57 AM |

    Impudent--

    Great idea.

    Perhaps I will send future emails and say that there are thousands of people reading this blog who will await their response!

  • Dr. William Davis

    4/11/2010 1:05:51 AM |

    Gary--

    Because we have only one Costco (i.e., only one store), we have had too few people buying this product to say with any confidence.

    It never hurts to have your blood level checked.

  • rhc

    4/11/2010 1:40:53 AM |

    You might consider me 'weird' but  I actually like to chew my fish oil capsules - I like the taste of the oil and the capsule itself. This has an added important benefit: I can taste if it's fresh BEFORE I swallow. I must say I've never had a rancid one yet. Presently am using Spring Valley from Walmart. I often do the same with my liquid vit D3 caps as well.

    Dr. Davis, thank you so much for all the info you put out for us.

  • Anonymous

    4/11/2010 1:54:25 AM |

    I am a fan of your blog, but honestly this is a very low standard of "proof" that you are using. If you feel strongly about it why not get a certificate of analysis done yourself?

  • Daniel Schroeder

    4/11/2010 4:00:08 AM |

    I'm a psych NP. My patient took 7000iu Naturemade tabs with no effect on blood level after 2 months. Have heard tabs don't absorb, so have stearing people away from them. Thanks for the info on their softgels.

  • Dr. William Davis

    4/11/2010 1:05:50 PM |

    If I had to get a "certifcate of analysis" performed for every supplement I questioned, we'd go bankrupt just on the testing.

    I'll be interested to see what organizations like Consumer Lab, who test a broad range of supplements, come up with.

  • TedHutchinson

    4/11/2010 7:41:25 PM |

    I subscribe to Consumerlabs.

    When they tested vitamin D3  (1/18/10) they only tested up to 1000iu/d capsules/tablet/liquid and also some combination products.

    I'm sure readers here are all aware  1000iu/daily can, at best, only raise 25(OH)D 10ng/ml = 25nmol/l.
    Most readers require significantly more than that to reach >50ng/ml+ ensuring their body has an emergency stored reserve supply of Vitamin D3.

    People who are overweight or suffer diabetes, Celiac or any other inflammatory condition will generally require even more than 1000iu/daily/D3 per 25lbs weight.

    The LEF report Startling Findings About Vitamin D Levels in Life Extension® Members By William Faloon shows IN PRACTICE 5000iu/daily/D3 averages only just above 42ng/ml so if we are trying to achieve a level that does more that just meet our daily requirements but also enables the body to store Vitamin D for emergencies, then we require MORE THAN just 5000iu daily/vitamin D3.

    At latitude 52 with a BMI just under 25 I take 5000iu/daily + regular short full body prone uvb/winter/sun/summer exposure
    My 25(OH)D stays @ 64ng/ml.

    I am not convinced Consumerlabs testing of tablet formulations of 400iu or even up to 1000iu has any relevance to correcting vitamin D insufficiency.

  • Douglas Jones

    4/11/2010 11:10:00 PM |

    Dr. Davis

    My name is Douglas Jones, I am with in Corporate Communications at Pharmavite the makers of Nature Made Vitamins.  We take your comments very seriously and need the information that Marissa asked for in her e mail.

    All of our products are tested fully before they are shipped to our customers.

    Please feel free to contact me directly at djones@pharmavite.net

    Thank you

  • Dr. William Davis

    4/12/2010 11:34:16 AM |

    Thank you, Mr. Jones.

    Because I identify these cases one by one over months, I don't have my patients bring in their bottles.

    I have to say that I am also impressed that I got beyond the girl in the cubicle on this one.

    In future, I will ask patients to bring the bottles in. If I know this leads somewhere, then it's worth the extra effort.

    However, I remain confident that there is a problem.

  • Heather Brandt

    4/13/2010 10:10:58 PM |

    Do you recommend multivitamins and/ or Vitamin D brands?

    I am 34 years old and at an ideal body weight but had moderately low HDL when blood work was done...Just following your blog and trying to figure out ways to raise my HDL and to help prevent heart disease (My mother is in her 50s and has been on statins for bad cholesterol, a path I don't want to follow).

    heatherlbrandt(at) verizon (dot) net

  • Anonymous

    5/18/2010 10:34:01 AM |

    I had been using NatureMade fish oils for years and no belchback. I got a batch that both my wife and I had bad belching with fish taste. Called the company and they said I had been using the enteric coated. I bought some of the enteric and they don't belch back, they also are not what we had been taking. Looks like I will be switching to a different company too.

  • dining tables

    7/6/2010 3:44:11 AM |

    My friends have been using NatureMade fish oil for over a year now. She told me that it is very effective. I think I am guess I will giving it a try.

  • Trem papers

    8/16/2010 10:25:23 AM |

    Hi, nice post. I have been thinking about this topic,so thanks for sharing. I will likely be coming back to your blog. Keep up the good work
    termpapers99@gmail.com

  • dlrose123

    10/19/2010 2:03:49 AM |

    In Nature Made's defense, I've been using 2,000 Vitamin D from Nature Made for the past 6 months, and my Vitamin D levels have risen about 20 points.  I've been very happy with the result, so I just started using their fish oil. I'm sitting here with a brand new bottle of their fish oil enteric coating 1200 mg pills, and smell no odor at all.  This doesn't mean other people haven't had different experiences, but it might be very dependent on your individual body chemistry, and I would suggest doing blood tests every 6 months to determine if the Vit. D you are taking is working for you.  And no, I do not work for Nature Made, and have no connections to them Smile

  • auto insurance quotes

    3/9/2011 1:13:12 AM |

    I just have to say that letter show what they think of customers and how they have made made their mind to deal with any complaints. They did not even bother to get a competent person who could write a letter. Forget that. They did not even bother to prepare a template response.

  • Anonymous

    3/17/2011 5:35:13 PM |

    There is interesting research on omega 3 bioavailability.

    After mixed results with various fish oil capsules resulting in low-tide burps or flatus, i moved to Coromega.  Wonderful product.

    Re Costco 2,000 iu oil capsules, i've raised my serum levels to 88 ng/ml with them.

    However, given the wide range of factors that affect D uptake/utilization, titrating to standard is the only useful methodology. Blind dosing, especially at very low serum levels, might not raise serum levels at all.

  • Anonymous

    3/17/2011 7:03:36 PM |

    Omega-3 structure may affect bioavailability: Study

    By Nathan Gray, 14-Jan-2011

    Related topics: Research

    The type of omega-3 we take may have a distinct affect on how much is actually absorbed, according to new research.


    The study, published in the European Journal of Lipid Science and Technology, suggests that omega-3 concentrates – such as triacylglycerides – have much better bioavailability than purified fish oild

    The team of Spanish researchers said that the study contributes to knowledge on the intestinal lipolysis of omega-3 sources, which can be found in many commercial forms, from purified fish oil to concentrates of free fatty acids and ethyl esters.

    They said that despite differences regarding their intestinal metabolism, there is lack of information about the specific composition of the absorbable fraction from omega-3-TAG or omega-3-EE concentrates.

    “This comparative study showed that the in vitro bioaccesibility of omega-3-polyunsaturated fatty acid (PUFA) seems to be better as omega-3-TAG concentrates than purified fish oils,” said the researchers, led by Dr. Diana Martin from the Universidad Autónoma de Madrid, Spain.

    Fish oil

    Consumption of fatty acids from the omega-3 family – particularly eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) – have been advised due to their beneficial role as anti-thrombotic, anti-inflamatory, and hypolipidemic fatty acids.

    The authors noted, however, that in many populations consumption of fish is quite low and does not achieve levels adequate for reaching the minimal intake level of EPA and DHA. They added that because of this, an easy way of increasing omega-3-polyunsaturated fatty acids (PUFA) intake is by the fish oils supplements oils.

    They said that recent studies have produced contradictory evidence for the in vitro metabolism of fish oils and omega-3-concentrates,

    The new study compared the in vitro bioaccesibility of omega-3-oils from different sources. The researchers tested salmon oil, tuna oil, enriched-omega-3 oil as triacylglycerols (omega-3-TAG), and enriched-omega-3 oil as ethyl ester (omega-3-EE).

    Study details

    Dr Martin and colleagues reported the rate of hydrolysis of omega-3-TAG concentrates was continuous throughout the time of reaction, whereas the digestion of salmon oil and tuna oil was initially faster but stopped after 10 min.

    They added that poor hydrolysis took place for the enriched-omega-3 oil as omega-3-EE.

    The breakdown of omega-3-TAG oil, salmon oil, and tuna oil mainly consisted of free fatty acids (FFAs) and monoacylglycerides, whereas the breakdown from digested omega-3-EE oil consisted of free fatty acids and undigested ethyl esters.

    “This comparative study showed that the in vitro intestinal digestion of omega-3 (EPA and DHA) sources as fish oil, triacylglycerides, or ethyl ester concentrates was different,” said Martin and colleagues.

    “The highest degree of hydrolysis and inclusion of lipid products … was found for the omega-3-TAG oil, but compared to fish oils long times of digestion were required,” they added.

    Source: European Journal of Lipid Science and Technology
    Volume 112, Issue 12, pages 1315–1322, doi: 10.1002/ejlt.201000329
    “Intestinal digestion of fish oils and ω-3 concentrates under in vitro conditions”
    Authors: D. Martin, J.A. Nieto-Fuentes, F.J. Señoráns, G. Reglero, C. Soler-Rivas

  • Anonymous

    3/17/2011 7:04:21 PM |

    http://www.adajournal.org/article/S0002-8223(09)00293-4/abstract

  • Anonymous

    3/17/2011 7:15:55 PM |

    Re vitamin D uptake & utilization, diet (taking D with a meal doubles uptake), existing D levels (see Holick re substrate starvation), D form (D2 v D3), exposure, lifestyle, age (over 50 produce less in skin), obesity (excess bf sequesters D), co-factors (affect utilization), genes, bathing (bathing strips oils off skin), etc. affect D serum levels.

    http://www.scribd.com/doc/38595990/D2-D3

    http://www.scribd.com/doc/37319962/Vieth-Vit-D

    http://www.scribd.com/doc/36940698/D-Test-and-Treat

    http://www.scribd.com/doc/45004628/D-review

    http://www.scribd.com/doc/49369766/Garland-021811

    "Vitamin D has co-factors that the body needs in order to utilize vitamin D properly. They are:
    magnesium
    zinc
    vitamin K2
    boron
    a tiny amount of vitamin A
    Magnesium is the most important of these co-factors. In fact, it is common for rising vitamin D levels to exacerbate an underlying magnesium deficiency. If one is having problems supplementing with vitamin D, a magnesium deficiency could be the reason why."

  • K.N.O.W. (Kids Need Our Wisdom)

    3/27/2011 9:30:17 AM |

    Dr. I came across your site while looking for someone who was having the same problem w/ their Vitamin D levels and not finding a solution.  In fact, the brand you mentioned has done nothing for me in any of the vitamin area!  However I did come across a vitamin that has taken care of my Vit D problem and other problems.  Honestly I think the brand I am taking is the ONLY brand that is actually helping people.  Everyone I know who gets on them has had great results!  Rob Dillon - rdillon4@cox.net

  • Study in UK

    4/14/2011 7:54:42 AM |

    Incidentally, I like the way you have structured your site, it is super and very easy to follow. I have bookmarked you and will be back regularly. Thank you

  • gareth

    9/7/2011 10:13:45 PM |

    i too have suffered from kidney stones. i did a 24 hour urine test and my calcium urine level was 3 times normal. shock horror all round.
    i began to take 5000iu of vitamin d3 daily and in a few weeks my calcium urine level was normal, my urologist was amazed that this had happened but i did not tell him why because english doctors do not believe in supplements and he would have had a hissy fit!!.
    since then, no more stones!

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The most important weight loss tool


Question: What is the most effective tool available to help you lose weight? 


A pedometer (walk 10,000 steps, etc.)?

A treadmill? 




A bicycle?






No. None of the above. 

The most important tool you can use to achieve weight loss is your glucose monitor:



Timing of blood sugars

Because different foods generate different blood sugar (glucose) responses, the timing of your blood sugar is an important factor to consider.

This question has come up a number of times. Commenters have asked whether the one-hour postprandial glucose is timed with the start of the meal or the conclusion of the meal.

In my view, if we simply ignored all aspects of meal composition, then blood glucose should be obtained one hour after the conclusion of a meal. This is because most mixed meals (i.e., mixed in composition among proteins, fats, and carbohydrates) yield peak blood glucose levels at 60-90 minutes after consumption. Timing blood glucose to 60 minutes after the conclusion of a meal puts the sample right about at the peak.

But this is an oversimplification. For instance, here is the blood glucose behavior after so-called "complex" carbohydrates wheat bread, rye bread, rye made with beta glucan, and whole wheat pasta (50 grams carbohydrates each) in slender, healthy volunteers, mean age 29 years:


From Juntunen et al 2002

Note that blood glucose peaks at 35 minutes postprandial. (To convert glucose in mmol/L to mg/dl, multiple by 18. Thus, whole wheat bread increased blood glucose from 94 mg/dl to 122 mg/dl. Also note the lower peak glucose for pasta, but sustained higher glucose levels hours later.)

In another study, older (mean age 64 years), overweight (BMI 27.9) females with diabetes were given 50 grams carbohydrate, 50 grams carbohydrate with olive oil, or 50 grams carbohydrate with butter:


From Thomsen et al 2003. Control meal of soup plus 50 g carbohydrates ({blacktriangledown}), the control meal plus 80 g olive oil ({circ}), and the control meal plus 100 g butter (•).

In this experience, note that postprandial glucose peaks 60-120 minutes after the meals (consumed within 10 minutes), delayed more when either oil is included. Blood glucose started at 144 mg/dl and peaked as high as 230 mg/dl with carbohydrates only; peaks were reduced (along with AUC) when oil was included. (Note the differential effect, olive oil vs. butter.)

These two sets of observations give you a range of blood glucose behavior. One side lesson: Carbohydrates should never consumed by themselves, else you will pay with a high blood sugar (not to mention the hypoglycemic response later for many).

Psssst . . . There's sugar in there

You non-diabetics who check your postprandial blood sugars already know: There are hidden sources of sugar in so many foods.

By now, everybody should know that foods like breakfast cereals, breads, bagels, pretzels, and crackers cause blood sugar to skyrocket after you eat them. But sometimes you eat something you thought was safe only to find you're showing blood sugars of 120, 130, 150+ mg/dl.

Where can you find such "stealth" sources of sugars that can screw up your postprandial blood sugars, small LDL, inflammation, blood pressure, and cause you to grow visceral fat? Here's a few:

Balsamic vinaigrette
Many commercially-prepared balsamic vinaigrettes, especially the "light" varieties, have 3 or more grams carbohydrates per tablespoon. Generous use of a sugar-added vinaigrette can therefore provide 12+ grams carbs. (Some, like Emeril's and Wish Bone, also contain high-fructose corn syrup.)

Hamburgers
I learned this lesson the hard way by taking my blood sugar after having a hamburger, turkey burger, or vegetarian burger (without bun): blood sugar would go way up. The effect is due to bread crumbs added to the meat or soy.

Tomato soup
If it were just tomatoes, it would still be somewhat high in sugars. But commercially-prepared tomato soup often contains added high-fructose corn syrup, sucrose, and wheat flour, bringing sugar totals to 12 to 20+ grams per half-cup. A typical 2-cup bowl of tomato soup can have upwards of 80 grams of sugar.

Granola
Sure, granola contains a lot of fiber. But most granolas come packed with sugars in various forms. One cup of Kellogg's Low-fat Granola with Raisins contains an incredible 72 grams (net) carbohydrates, of which 25 grams are sugar.


Given modern appetites and serving sizes, you can see that it is very easy to get carried away and, before you know it, get exposed to extraordinary amounts of sugar and carbohydrates eating foods you thought were healthy.

And don't be fooled by claims of "natural" sugar. Sugar is sugar--Just check your blood sugar and you'll see. So raw cane sugar, beet sugar, and brown sugar have the same impact as white table sugar. Honey, maple syrup, and agave? They're worse (due to fructose).

How low should blood sugar be?

What should your blood sugar (glucose) be after eating?

Take a look at the data from the Whitehall study reported in 2006. The Whitehall Study stands apart from other studies in that it was very large (over 18,000 participants) who were observed for an unusually long time (33 years). All participants were administered a 50 gram glucose "challenge" at the start with glucose levels checked after the glucose challenge.

Here's what they found:




From Brunner et al 2006.

You just THINK you're low-carb

Systematically checking postprandial (after-eating) blood sugars is providing some great insights into crafting a better diet for many people.

I last discussed the concept of postprandial glucose checks in To get low-carb right, you need to check blood sugars.

Here are some important lessons that many people--NON-diabetic people, most with normal blood glucoses or just mildly increased--are learning:

Oatmeal yields high blood sugars. Even if your fasting blood sugar is 90 mg/dl, a bowl of oatmeal with skim milk, walnuts, and some berries will yield blood sugars of 150-200 mg/dl in many people.

Cheerios yields shocking blood sugars. 200+ mg/dl is not uncommon in non-diabetics. (Diabetics have 250-350 mg/dl.)

Fruits like apples and bananas increase blood sugar to 130 mg/dl or higher.

Odd symptoms, such as mental "fog," fatigue, and a fullness in the head, are often attributable to high blood sugars.

A subset of people with lipoprotein(a) can have wildly increased blood sugars despite their slender build and high aerobic exercise habits.


Once you identify the high blood sugar problem, you can do something about it. The best place to start is to reduce or eliminate the sugar-provoking food.

The LDL-Fructose Disconnect

I believe that we can all agree that the commonly obtained Friedewald LDL cholesterol (what I call "fictitious" LDL cholesterol) is wildly inaccurate. 100%--yes, 100% inaccuracy--is not at all uncommon.

This flagrant inaccuracy, unacceptable in virtually every other discipline (imagine your airplane flight to New York lands in Pittsburgh--close enough, isn't it?), is highlighted in the University of California study by Stanhope et al I discussed previously.

32 participants consumed either a diet enriched with either fructose or glucose. Compared to the effect of glucose, after 10 weeks fructose:

Increased LDL cholesterol (calculated) by 7.6%

Increased Apoprotein B (a measure of the number of LDL particles) by 24%

Increased small dense LDL by 41%

Increased oxidized LDL by 12.6%



In other words, conventional calculated LDL substantially underestimates the undesirable effects of fructose. The divergence between calculated LDL and small LDL is especially dramatic. (By the way, this same divergence applies to the studies suggesting that calculated LDL cholesterol is reduced by low fat diets--While calculated LDL may indeed be reduced, small LDL goes way up, a striking divergence.)

This is yet another reason to not rely on this "fictitious" LDL cholesterol value that, inaccuracies notwithstanding, serves as the foundation for a $27 billion per year industry.

"I dream about bread"

Marion sat in my office, sobbing.

It had been 4 weeks since the last piece of bread, bagel, or bun had passed her lips.

"I can't do it! I just can't do it! I've tried to eliminate wheat, but it's making me crazy. I'm having dreams about bread!"

Yes, Timmy, such dark corners of human behavior are truly unveiled by removing wheat from the diet. (See the previous Heart Scan Blog post, Wheat withdrawal.)

This is a real phenomenon: Wheat is the crack cocaine of the masses. Maybe you don't exchange $100 bills in dark corners of an inner city crack house, but I'll bet you paid $3.99 for your latest fix of French bread.

Just in the last 2 weeks, people in my office who have eliminated wheat have experienced:

14 lbs weight loss in 14 days

Increased mental clarity, reduced moodiness, deeper sleep

70% reductions in small LDL

More than 300 mg/dl reductions in triglycerides

Relief from chronic scalp rash


I could go on.

All the while, the USDA, the American Heart Association, the American Diabetes Association, the American Dietetic Association, the Surgeon General's Office all advise you to eat more "healthy whole grains."

70% of people (NOT 100%, but the majority) will experience unexpected health benefits by eliminating this corrupt, unphysiologic product called wheat from their diet.

You won't know until you try.

Prototypical Lipoprotein(a)

Here's the prototypical male with lipoprotein(a):



Several features stand out in the majority of men with lipoprotein(a), Lp(a):

Slender--Sometimes absurdly so: BMIs of 21-23 are not uncommon. These are the people who claim they can't gain weight.

Intelligent--Above average to way above average intelligence is the rule.

Gravitate to technical work--Plenty of engineers, scientists, accountants, and other people who work with numbers and/or technical details are more likely to have Lp(a).

Enjoy high levels of aerobic performance--I tell my Lp(a) patients that, if they want to see a bunch of other people with Lp(a), go to a marathon or triathlon. They'll see plenty of people with the pattern among the aerobically-elite.

Are rabid fans of Star Trek.


Okay, I made the last one up. But the rest are uncannilly true, shared by the majority (though not all) men with Lp(a).

Why? I can only speculate that the gene(s) for Lp(a) are closely linked to gene(s) for intelligence of a quantitative kind and some factor that enhances aerobic performance or yields a desirable emotional state with exercise.

Oddly, the same patterns tend not to occur in women in Lp(a). I have yet to discern a personality or body configuration phenotype among the ladies.

Gastric emptying: When slower is better

When it comes to the Internet and Nascar, speed is good: The faster the better.

But when it comes to gastric emptying (the rate at which food passes from the stomach and into the duodenum and small intestine), slower can be better.

Slower transit time for foods passing through the stomach leads to lower blood sugar, lower blood glucose area under-the-curve (AUC), i.e., reduced blood glucose levels over time. Lower postprandial (after-eating) blood sugars can reduce cardiovascular risk. It can lead to a reduction in net calorie intake and weight loss.

Strategies that can slow gastric emptying include:

--Minimizing fluids during a meal--Drinking a lot of fluids, e.g., water, accelerates gastric emptying by approximately 20%.

--Cinnamon--While the full reason to explain Cassia cinnamon's blood glucose-reducing effect has not been completely worked out, part of the effect is likely to due slowed gastric emptying. Thus, a 1/4-2 teaspoons of cinnamon per day can reduce postprandial blood sugar peaks by 10-25 mg/dl.

--Vinegar--Two teaspoons of vinegar in its various forms slows gastric emptying. The effect is likely due to acetic acid, the compound shared by apple cider vinegar, white vinegar, red wine vinegar, Balsamic vinegar, and other varieties.

--Increased fat content--Fat is digested more slowly and slows gastric emptying time, compared to the rapid transit of carbohydrates.

Not everybody should slow gastric emptying. Diabetics with a condition called diabetic gastroparesis should not use these methods, as they can further slow the abnormal gastric emptying that develops as part of their disease, making a bad situation worse.

However, in the rest of us with normal gastric emptying time, a delay in gastric emptying can reduce blood sugar and induce satiety, effects that can work in your favor in reducing cardiovascular risk.